Skip to main content
Log in

New technologies and therapeutic approaches for the management of pediatric diabetes

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Evolving trends in technology and therapeutic strategies create a very exciting time for the management of diabetes. Technology, like the internet, helps us to keep up with this fast-paced, changing world of diabetes. New therapies most often begin with adult clinical trials; once safety and efficacy are demonstrated, practice recommendations follow for the pediatric population.

The Diabetes Research Working Group has defined potentially important new directions and technologies for diabetes research. The group has recommended the creation of regional centers of technologic excellence, if contemporary diabetes research is to succeed. An overview of recent advances in diabetes technology follows covering five main areas: monitoring, telemedicine, insulin analogues, insulin delivery devices, and islet cell transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. US Department of Health and Human Services: NIH Workgroup Report: Conquering Diabetes A Strategic Plan for the 21st Century. Washington DC: Office of the National Institutes of Health (NIH Publication No. 99-4398); 1999. This report sets forth a strategic plan for initiatives in diabetes research. It summarizes the magnitude of the problem of diabetes in the United States. The working group makes recommendations based on the assessment of the problems, research opportunities, and needs.

    Google Scholar 

  2. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329:977–986. This landmark study of 1441 patients with type 1 diabetes supported the hypothesis that intensive management of diabetes results in improved outcomes. It supports the need for technology-based research to find better ways to manage diabetes through improved tools and treatment.

    Article  Google Scholar 

  3. Personal Lasette resources page. Cell Robotics International, Inc. website. Available at: http://www.cellrobotics.com/ perslasette.html. Accessed May 2001.

  4. Fineberg SE, Bergenstal RM, Bernstein RM, et al.: Use of an automated device for alternative site blood glucose monitoring. Diabetes Care 2001, in press.

  5. D’Arrigo T: New products. Diabetes Forecast 2001, 54:42–45.

    Google Scholar 

  6. Byrne HA, Tieszen KL, Hollis S, et al.: Evaluation of an electrochemical sensor for measuring blood ketones. Diabetes Care 2000, 23:500–503.

    Article  PubMed  CAS  Google Scholar 

  7. Laffel L: Sick day management of type 1 diabetes. Endocrinol Metab Clin North Am 2000, 29:707–723.

    Article  PubMed  CAS  Google Scholar 

  8. Fineberg SE, Brink SJ, Kaufman F, et al.: Comparison of blood beta-hydroxybutryate and urine ketones in 4 weeks of home monitoring by insulin-requiring children and adults. Diabetes 2000, 49:A105.

    Google Scholar 

  9. Laffel L, Brink S, Kaufman F, et al.: Frequency of elevation in blood b-hydroxybutyrate (b-OHB) during home monitoring and association with glycemia in insulin-treated children and adults. Diabetes 2000, 49:A92.

    Google Scholar 

  10. Lawlor MT, Laffel LMB, Anderson BJ, Bertorelli AM: Introduction monitoring. In Caring for Young Children Living with Diabetes Professional Manual. Boston: Joslin Diabetes Center; 1996:55–62.

    Google Scholar 

  11. Lawlor M, Laffel LMB, Anderson BJ: Blood Sugar Monitoring Owner’s Manual. Boston: Joslin Diabetes Center; 1997. The use of this patient education material is to illustrate the human side of managing diabetes. Patients and families must see a value in using current or emerging diabetes management tools and treatments. If behaviors and lifestyles are in conflict with these tools and treatments, outcomes will not be improved.

    Google Scholar 

  12. Koschinsky T, Heinemann: Sensors for glucose monitoring: technical and clinical aspects. Diabetes Metab Rev 2001, 17:113–123.

    Article  CAS  Google Scholar 

  13. Mastrototaro JJ: The MiniMed continuous glucose monitoring system. Diabetes Technol Ther 2000, 2:S13–1834.

    Article  PubMed  Google Scholar 

  14. Aussedat B, Dupire-Angel M, Gifford R, et al.: Interstitial glucose concentration and glycemia: implications for continuous subcutaneous glucose monitoring. Endocrinol Metab 2000, 278:E716-E728.

    CAS  Google Scholar 

  15. Gross TM, Veer AT: Continuous glucose monitoring in previously unstudied population subgroups. Diabetes Technol Ther 2000, 2:S27–34.

    Article  PubMed  Google Scholar 

  16. Chase HP, Kim LM, Owen SL, et al.: Continuous subcutaneous glucose monitoring in children with type 1 diabetes. Pediatrics 2001, 107:222–226.

    Article  PubMed  CAS  Google Scholar 

  17. Kaufman FR: Role of continuous glucose monitoring in pediatric patients. Diabetes Technol Ther 2000, 2:S49–52.

    Article  PubMed  Google Scholar 

  18. Boland EA, Tamborlane WV: Continuous glucose monitoring in youth with type 2 diabetes: overcoming barriers to successful treatment. Diabetes Technol Ther 2000, 2:S53–59.

    Article  PubMed  Google Scholar 

  19. GlucoWatch Biographer resources page (by Cygnus). Available at: http://www.glucowatch.com. Accessed May 2001.

  20. Tamada JA, Garg S, Jovanovic L, et al.: Noninvasive glucose monitoring: comprehensive clinical results. JAMA 1999, 282:139–184.

    Article  Google Scholar 

  21. Garg SK, Potts RO, Ackerman NR, et al.: Correlation of fingerstick blood glucose measurements with GlucoWatch Biographer glucose results in young subjects with type 1 diabetes. Diabetes Care 1999, 22:1708–1714.

    Article  PubMed  CAS  Google Scholar 

  22. Eastman RC, Hathout E, Fuller_Byk L, et al.: Accuracy of the GlucoWatch Automatic Glucose Biographer in subjects 7–17 years of age with diabetes. Diabetes 2001,

  23. Pichert JW, Campbell K, Cox DJ, et al.: Issues for the coming age of continuous glucose monitoring. Diabetes Educator 2000, 26:969–980.

    PubMed  CAS  Google Scholar 

  24. Bailey TS: How to communicate home blood glucose monitoring data more effectively: a ’low-tech’ fax solution to a common diabetes data management dilemma. C lin Diabetes 1999, 17:85–86.

    Google Scholar 

  25. Aiello LM, Cavallerano J, Cavallerano A, Bursell SE: The Joslin Vision Network innovative telemedicine care for diabetes. Opthalmol Clin North Am 2000, 13:213–224.

    Article  Google Scholar 

  26. Bursell SE, Cavallerano JD, Cavallerano AA, et al.: Stereo nonmydriatic digital-video color retinal imaging compared with early treatment diabetic retinopathy study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Opthalmology 2001, 108:572–585.

    Article  CAS  Google Scholar 

  27. Lando HM: The new “Designer” insulin. Clin Diabetes 2000, 18:154–160.

    Google Scholar 

  28. Lalli C, Ciofetta M, DelSindaco P, et al.: Long-term intensive treatment of type 1 diabetes with the short-acting insulin analog lispro in variable combination with NPH insulin at mealtime. Diabetes Care 1999, 22:468–477.

    Article  PubMed  CAS  Google Scholar 

  29. Brunelle RL, Llewelyn J, Anderson JH, et al.: Meta-analysis of the effect of insulin lispro on severe hypoglycemia in patients with type 1 diabetes. Diabetes Care 1998, 21:1726–1731.

    Article  PubMed  CAS  Google Scholar 

  30. Rutledge KS, Chase HP, Klingensmith GJ, et al.: Effectiveness of postprandial Humalog in toddlers with diabetes. Pediatrics 1997, 6:968–972.

    Article  Google Scholar 

  31. Raskin P, Guthrie RA, Leiter L, et al.: Use of insulin aspart, a fast-acting insulin analog, as the mealtime insulin in the management of patients with type 1 diabetes. Diabetes Care 2000, 23:583–588.

    Article  PubMed  CAS  Google Scholar 

  32. Heinmann L, Linkeschova R, Rave K, et al.: Time-action profile of the long acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo. Diabetes Care 2000, 23:644–649.

    Article  Google Scholar 

  33. Raskin P, Klaff L, Bergenstal R, et al.: A 16-week comparison of the novel insulin analog glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care 2000, 23:1666–1671.

    Article  PubMed  CAS  Google Scholar 

  34. Ratner RE, Hirsch IB, Neifing JL, et al.: Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000, 23:639–643.

    Article  PubMed  CAS  Google Scholar 

  35. Kaufman F: Insulin pump therapy in type 1 pediatric patients: now and into the year 2000. Diabetes Metab Rev 1999, 15:338–352. An excellent overview of the issues and mechanics of the insulin pump in the pediatric population. Pump therapy is reviewed, paying close attention to the tools, developmental issues, family dynamics, and how all of these factors affect diabetes management.

    Article  CAS  Google Scholar 

  36. Clinical Practice Recommendations 2001—continuous subcutaneous insulin infusion [no authors listed]. Diabetes Care 2001, 24:S98.

  37. Kaufman FR, Halvorson M, Kim C, Pitukcheewanont P: Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes. Diabetes Care 2000, 23:579–582.

    Article  PubMed  CAS  Google Scholar 

  38. Kanc K, Janssen MMJ, Keulen ETP, et al.: Substitution of nighttime continuous insulin infusion therapy for bedtime NPH insulin in a multiple injection regime improves counter regulatory hormonal response and warning symptoms of hypoglycemia in IDDM. Diabetologia 1998, 41:322–329.

    Article  PubMed  CAS  Google Scholar 

  39. Sansum Medical Research Institute website. Press Release: Trial tests on insulin pumps offers hope to diabetics [December 27, 2000]. Available at: http://www.sansum.org/pressmolina.htm. Accessed May 2001

  40. Skyler JS, Cefalu WT, Kourides IA, et al.: Efficacy of inhaled human insulin in type 1 diabetes mellitus: a randomized proof-of-concept study. Lancet 2001, 357:324–325.

    Article  Google Scholar 

  41. Cefalu WT, Skyler JS, Kourides IA, et al.: Inhaled human insulin treatment in patients with type 2 diabetes mellitus. Ann Intern Med 2001, 134:203–207.

    PubMed  CAS  Google Scholar 

  42. Shapiro AMJ, Lakey JRT, Ryan EA, et al.: Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000, 343:230–238. Reports results of seven patients attaining insulin independence after receiving islet cell transplantation and glucocorticoid-free immunosuppressive. Its results have led to a multicenter clinical trial aimed at replicating the findings in a larger sample. Although the protocol itself may not be applicable to the vast majority of persons with type 1 diabetes, the study has created a great deal of hope that transplantation will be an effective and available treatment for type 1 diabetes in the future.

    Article  PubMed  CAS  Google Scholar 

  43. Ryan EA, Lakey JRT, Rajotte RV, et al.: Clinical outcomes and insulin secretion after islet transplantation with the Edmonton Protocol. Diabetes 2001, 50:710–719.

    Article  PubMed  CAS  Google Scholar 

  44. Serup P, Madsen OD, Mandrup-Poulson T: Islet and stem cell transplantation for treating diabetes. BMJ 2001, 322:29–32.

    Article  PubMed  CAS  Google Scholar 

  45. NIH stem cell information page. National Institutes of Health website. Available at: http://www.nih.gov/news/stemcell/ index.htm. Accessed May 2001.

  46. Bonner-Weir S, Taneja M, Weir GC, et al.: In vitro cultivation of human islets from expanded ductal tissue. Proc Natl Acad Sci U S A 2000, 97:7999–8004.

    Article  PubMed  CAS  Google Scholar 

  47. Lumelsky N, Blondel O, Laeng P, et al.: Differentiation of embryonic stem cells to insulin-secreting structures similar to pancreatic islets. Science [serial online]. April 2001, 10:1126. Available at: http://www.scienceonline.org. Accessed May 2001.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lawlor, M.T., Laffel, L.M.B. New technologies and therapeutic approaches for the management of pediatric diabetes. Curr Diab Rep 1, 56–66 (2001). https://doi.org/10.1007/s11892-001-0011-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-001-0011-0

Keywords

Navigation